Tomorrow is too late when relief is within reach.

Waiting is a treatment decision. Every week a referral sits in a queue is a week of pain someone chose for you. Infusion Center US is built to close that gap. Most patients receive their first treatment within 48 hours of referral.

Speed is half the design. The other half is refusing to infuse the symptom and ignore the engine behind it.

Not sure this is your service? Tap the directory assistant (the light in the corner of the page) and it will point you to the right place. This page sits in our pain and metabolic medicine directory.

Why are so many people chronically ill and on medication?

It is not an accident. Over 93% of adults have metabolic dysfunction, and that dysfunction fuels chronic disease and lifelong medication dependency.

The mechanism runs in a loop:

1. Ultra-processed food engineered by Big Food drives insulin resistance.
2. Insulin resistance drives diabetes, hypertension and cardiovascular disease.
3. Big Pharma sells the drugs that manage the damage.
4. The patient stays sick, and the profits keep rolling.

Cardiovascular disease, the leading cause of death worldwide, is largely preventable through metabolic health. Yet billions are spent on drugs that manage symptoms instead of on prevention.

Breaking the loop starts with measuring it.

What does Infusion Center US measure?

Infusion Center US uses the Measura assessments to show you and your physician, in real time, how your body is actually working. Three systems are assessed:

• Autonomic function
• Metabolic function
• Cardiovascular function

The assessments produce accurate, reproducible, real-time functional markers for:

• Insulin resistance
• Blood flow
• Pro-thrombosis, the tendency to clot
• Pro-inflammatory state
• Vascular tone

The suite spells its own name:

• Metabolic: metabolic rate, calculated versus measured
• ES-BC: the bioimpedance body composition analyzer
• ANS: autonomic nervous system assessment
• Sudomotor: the sudomotor function system
• Utilization: carbohydrate versus fat burning
• Respiratory: oxygen saturation
• ABI: ankle-brachial indices and plethysmography

Those numbers turn a vague complaint into a treatment target. They also show whether the target is moving. For the full testing service, see autonomic and vascular testing.

Who directs the infusion care?

Dr. Gurpreet Singh Padda, MD, MBA, MHP. Infusion is anesthesia work before it is anything else, and his training is anesthesia first.

• Anesthesia residencies at Illinois Masonic and Washington University / Barnes, with pediatric anesthesia, Chief Resident 1991 to 1992
• Diplomate of the American Board of Anesthesiology, the American Board of Pain Medicine and the American Board of Interventional Pain Management
• Assistant Professor of Anesthesiology, 1992 to 1999, and Director of the Pediatric Acute Pain Management Service, 1995 to 1999, where he built a multidisciplinary acute pain team
• Chairman of two hospital departments of anesthesia, perioperative medicine and pain management, and regional director of anesthesiology
• Diplomate of the American Board of Addiction Medicine, which matters when the drug on the pump is a controlled substance

Ketamine is an anesthetic. Screening, dosing and monitoring it is the job he trained for.

Which infusions does the practice use for pain?

The clearest case is ketamine for nerve pain.

Why ketamine?

Ketamine blocks the NMDA receptor. In reflex sympathetic dystrophy (RSD), also called complex regional pain syndrome (CRPS), and other refractory nerve pain, repeated pain signaling drives glutamate onto NMDA receptors in the spinal cord. The response amplifies over time. That amplification is the leading explanation for why light touch starts to feel like injury. Block the receptor and you turn down the amplifier.

Who is a candidate?

• RSD or CRPS meeting the Budapest clinical criteria, or documented neuropathic pain with allodynia
• An inadequate response to standard care: membrane-stabilizing medication, sympathetic blocks, desensitization and physical therapy
• No medical condition that makes ketamine unsafe

Ketamine is not a first step. It is not a substitute for finishing the diagnosis. If other treatable causes have not been excluded, that comes first.

Which route?

The Padda Institute uses ketamine three ways: intravenous infusion, sublingual preparations that dissolve under the tongue, and topical cream on the painful area. For RSD and CRPS, sublingual or topical is typically where treatment starts. Intravenous infusion is also available.

The evidence does not transfer between routes. If someone quotes an infusion trial while handing you a jar of cream, those two things have little to do with each other.

• Intravenous. The strongest data come from a randomized, double-blind trial of 60 patients with CRPS type 1. A 100-hour continuous inpatient infusion lowered pain against placebo through roughly week 11 and lost separation by week 12. Two limits rarely get quoted: function did not improve, only pain scores, and psychomimetic side effects hit 76% of patients. Short outpatient infusions are not what that trial studied.
• Topical. In a controlled crossover trial of 20 CRPS patients, 10% ketamine cream reduced brush-evoked pain and pinprick hypersensitivity, with blood levels undetectable. The effect was local, measurable the same day, and its duration was never measured.
• Sublingual. There is no controlled efficacy evidence in these conditions. It is used because it is practical and better tolerated than an infusion.

Because the IV trial improved pain but not function, ketamine runs alongside desensitization and physical therapy, never in place of them.

What does each route feel like?

• Topical cream goes on the painful area. In the trial setting, the effect on touch-evoked pain was measurable the same day.
• Sublingual preparations dissolve under the tongue. Dosing is individualized. There is no trial-established schedule to point to, and you are told so.
• Intravenous infusion runs in the clinic under monitoring, described below.

Duration is route-specific and the honest numbers are thin. That is the reason the plan is built on your response, not on a promise.

What happens during an IV ketamine infusion?

Screening before. Monitoring throughout: blood pressure, pulse and oxygen saturation. No driving afterward; someone takes you home.

Expect dissociation, vivid dreams, confusion and sedation, plus nausea and rises in blood pressure and heart rate. Repeated or prolonged exposure can cause ulcerative cystitis, a painful bladder condition that is sometimes irreversible, and liver and bile duct injury. Ketamine is a Schedule III controlled substance with a risk of misuse and dependence.

It is generally avoided in uncontrolled high blood pressure, unstable heart or cerebrovascular disease, raised pressure inside the skull or eye, psychosis, significant liver disease, pregnancy and active substance use.

Is ketamine approved for chronic pain?

No. The FDA approves ketamine as an anesthetic, so every use for chronic pain is off-label. Off-label prescribing is legal and common, and you are told when it applies to you. Topical and sublingual forms are compounded to order by a compounding pharmacy, and compounded drugs are not evaluated by the FDA for potency, purity or effectiveness. Consensus guidance from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine and the American Society of Anesthesiologists says the evidence varies by condition and dose, that most studies are small and uncontrolled, and sets monitoring standards for intravenous use only.

What about a migraine that will not break?

When oral medication has failed or vomiting makes swallowing pointless, the practice's headache clinic gives IV migraine therapy: an anti-nausea agent, fluids, magnesium and an anti-inflammatory, never an opioid. Details are on the headache and migraine treatment page.

Why pair infusion with metabolic testing?

Because an infusion calms a nervous system that the metabolism keeps provoking.

Insulin resistance, inflammation and poor blood flow are the terrain chronic pain grows in. Metabolic dysfunction drives insulin resistance, diabetes, obesity, hypertension, PCOS, osteoarthritis, anxiety, depression, addiction, hedonic substitution and pain, all through metabolic inflammation. Treat the pain alone and the terrain sends it back. Measure the terrain and you can change it. For drug-free options, see non-opioid pain treatment; for the practice's approach to opioids, see opioid stewardship.

What does it offer referring physicians?

Independent practice is under pressure. Over 60% of independent physicians are burned out. Their inflation-adjusted income has fallen by half in ten years while expenses climb. Their patients are not getting healthier either: over 93% now have metabolic dysfunction.

Infusion Center US offers physicians the Measura assessments as an ancillary service that does not eat into professional time. The practice describes it as a free solution that does not cost the referring practice a dime and improves revenue, while giving patients the critical health insights they need. Physicians can book a call to discuss it.

How do you start?

• Start My Infusion: register through Infusion Center US and the team contacts you.
• Book a call to talk through whether infusion fits.
• Ask your physician to refer you, and bring the real answers the assessments give you back to them.

Ketamine care is delivered at the Padda Institute, 4477 Woodson Rd, Suite 100, St. Louis, MO 63134, serving St. Louis, St. Louis County and St. Charles and drawing patients from across Missouri and Illinois. Call (314) 481-5000 or text (314) 886-5902 to discuss your diagnosis and whether ketamine fits your plan.

Frequently asked questions

How fast is the first treatment?

Most patients receive their first treatment within 48 hours of referral.

Do I need testing before an infusion?

The assessments are how you and your physician see insulin resistance, inflammation and blood flow, the markers that guide both treatment and lifestyle change. Ask which ones fit your case.

Is IV ketamine where CRPS treatment starts?

Usually not. For RSD and CRPS, sublingual or topical ketamine is typically first. IV infusion is available when it fits.

How long does ketamine relief last?

It depends on the route. Roughly eleven weeks after the multi-day inpatient infusion that was studied, same-day for the cream, and unmeasured for sublingual.

Can I drive after an infusion?

Not after IV ketamine. Arrange a ride home.

What should I ask my own doctor?

Ask for real answers, not another prescription. Ask what your insulin resistance, inflammation and blood flow actually measure, and what the plan is to move them. A symptom managed without those numbers is a symptom rented, not solved.

Why not start with the strongest option?

Because strongest is not safest. The IV trial that showed pain relief used a 100-hour inpatient infusion, showed no gain in function, and caused psychomimetic side effects in three of four patients. The gentler routes come first for a reason.